Individual
CHARLES SIMONSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1255 AVENUE D, MARRERO, LA 70072-3127
(504) 347-5435
(504) 347-2119
Mailing address
1255 AVENUE D, MARRERO, LA 70072-3127
(504) 347-5435
(504) 347-2119
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD012837
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1146846
—
LA
Enumeration date
10/12/2007
Last updated
10/12/2007
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